What’s a Midwife to do?

The Royal College of Midwives is making a considered change to the way it presents its advice on childbirth.

The RCM are still advising mothers to give birth without surgical intervention, if possible. The wording and emphasis though is changing.

The immediate, prompt for this is a scandal at Morecambe Bay where midwives are accused of being “over zealous” in advocating non surgical births. This caused babies to die. A major enquiry is underway.

There is more to this though. Government policy follows the old RCM line and we think it has used this to excuse closures of obstetrics (Specialist Child Birth Doctors) based facilities.

Simon Stevens, Head of NHS England works to a key document called the Five Year Forward View. In the view of many NHS campaigners, this a blueprint for cuts, of up to £22 billion, privatisation and preparation for a free trade deal which will allow big US health care firms to take over sections of the NHS, for profit.

The parallel document for Maternity is called the Maternity Review . Merseyside and Cheshire area is a Vanguard area for the maternity review and which has some projects that our campaign views with concern.

Personal budgets are, we believe, unworkable except to help an Accountable Care system monitor and limit spending on maternity. Our hospital though is trialling personalised budgets.

The Maternity Review was based on consultation with the National Child Birth Trust and the Women’s Institute. This consultation produced a suggestion that maternity provision be judged as successful depending on choice and on how few interventions were required.

The Review is written in sugar sweet language but is not as it appears. We have written an earlier post on this.

This “no interventions” ideal was linked to home births. and births in the community which was expected to save money. This in turn was linked to “other providers” which is code for private, for profit midwife companies and “pop up” midwife units.

It is linked to making access to an obstetrician an elective rather than an emergency service, including considerable closures and reconfiguration.

Thus the longer journey to an obstetrics hospital becomes more acceptable.

“Overall, we do not feel that there is sufficient evidence in the papers referenced to justify a conclusion that increased travel times to the nearest maternity unit (at less than four hours distance) are associated with an increased risk of either stillbirth and/or neonatal death.”

“Mr McLachlan admitted there was plausible evidence that it may lead to a higher number of babies born before reaching hospital. But said it was “reassuring” that even if these were more frequent, overall perinatal mortality rates aren’t “significantly” affected by longer travel times, again referencing journeys of up to four hours.”

We believe changes to midwives’ supervision are linked to this as are issues around insurance.

There are several key professions involved in pregnancy and birth and it is worth looking at the two best known role.

“These specialist groups are midwives – specialists in normal pregnancy and birth – and obstetrician – specialists in the care of women who fall outside of this remit. Midwives are trained to be expert in normal births and refer women when care deviates from this.” patientsafety.health.org.uk/

Midwife and bump

There are a many midwife led units around the country

Home births can be truly fabulous. But there are risks. It is not advised for first time mothers or those with complications. It is common for such births to transfer to hospital.

One in four mothers delivering in midwife units transfers to hospital. Think about that. Each transfer would be judged a failure on the” lack of interventions equals success” model. In real life the transfer is a godsend and saves both lives and suffering.

We wait to see if this statement from the RCM signals changes in the Maternity Review and in its Vanguard projects.

Meanwhile the Royal College of Midwives says of the current crisis in the NHS

These factors are made worse by some of the challenges facing the midwifery profession. Around 3,500 full-time midwives short, the pressure created by the lack of staff actually forces even more staff to leave because of the intolerable pressure caused by the shortage. With the workforce growing at a snail’s pace, money is wasted on short-term agency staff instead of on fixing the problem of not having enough permanent midwifery staff.

The profession is ageing rapidly, with over 1,000 NHS midwives in England now in their sixties; one in three is now over the age of 50. An inability and unwillingness to offer flexible working opportunities to midwives juggling family commitments leads to even more leaving the profession.

Student numbers are dipping just as full tuition fees are introduced and bursaries are abolished. Early signs point to a drop of almost a quarter in applications for nursing and midwifery courses at our universities. All at a time when a huge question mark hangs over the future of more than 1,300 EU midwives who work in the NHS in England.”

Save Liverpool Women’s Hospital Campaign wants to keep and to improve Liverpool Women’s Hospital. We see the threats to the Hospital in the context of the very real threats to the NHS as a universal, comprehensive, not for profit service, paid from taxation and free at the point of need. We have seen crazy wasteful innovations like the internal market and concepts of competition, brought into the NHS. We have seen stress in the workforce and cuts for patients. We have seen big business making money from the NHS, money that should go to patient care and staff pay, It is beyond belief that the drastic changes proposed for Liverpool Women’s hospital are in some kind of bubble which separates the hospital from the rest of the NHS, allowing a spend of way over £100 million when all around services are cut and staff pay is capped.

We also campaign for many more midwives to be trained, we want more flexible working to be much more widely available and we want the return of the bursaries. It is madness to remove them at this time of shortage

We will continue to advocate mothers having access to natural/ normal births and to obstetrics birth optionns. Above all for mothers to be listened to and to be heeded. We want more care for mums and babies in the first weeks after birth.

We will continue to campaign for local maternity provision across the UK with full funding.

We hope that the next government fully funds the NHS and returns it to being a universal, comprehensive, not for profit service funded from taxation. Meanwhile our campaign will continue to grow.

As ever, we would love to hear officially or quietly from more of those on the front line.

For all our mothers, sisters, daughters, friends and lovers and for our precious babies.

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